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Biomedical subjects

G Robert

Publications and source records attributed to G Robert.

At least 19 recordsLinked to original sources
PubMed2000

Cost of quality management and information provision for screening: colorectal cancer screening.

OBJECTIVE: To estimate the costs of a quality management (QM) system as proposed by the Quality Management for Screening report for a future national colorectal cancer screening programme. METHODS: Estimates of the costs of the QM system, including the associated costs of education and training and information provision, were based on expert opinion, the existing literature, and the experience of the current National Health Service (NHS) breast cancer screening programme (BSP) and the NHS cervical cancer screening programme (CSP). RESULTS: The cost of a QM system to support a national colorectal cancer programme in the UK was estimated as approximately 3.8 million a year. Further annual costs related to QM will include 500000 for education and training and 200000 for information provision. Adding these additional costs to a previously published UK economic evaluation of colorectal cancer screening increases the cost-utility ratio to approximately 6500 per quality adjusted life year gained (over an eight year follow up period). CONCLUSIONS: Any new screening programme, or an existing one, must have QM to ensure that the quality of screening is high and to maintain the right balance between benefit and harm. The significant costs of such a QM system should be included in any economic evaluation of a screening programme.

Budgets↗
PubMed2000

Medical document anonymization with a semantic lexicon.

We present an original system for locating and removing personally-identifying information in patient records. In this experiment, anonymization is seen as a particular case of knowledge extraction. We use natural language processing tools provided by the MEDTAG framework: a semantic lexicon specialized in medicine, and a toolkit for word-sense and morpho-syntactic tagging. The system finds 98-99% of all personally-identifying information.

Computer Security↗
PubMed2000

Tagging medical texts: a rule-based experiment.

In this paper we describe the construction of a part-of-speech tagger for medical document retrieval purposes, therefore we have designed a specific architecture called minimal commitment. The system uses local grammatical rules for conducting the disambiguation task. Four evaluations are conducted, with and without taking unknown words into account. In between each evaluation the modules (lexicon, guesser, rules) of the system are incrementally improved.

Disease↗
PubMed1999

A Delphi study to establish national cost-effectiveness research priorities for positron emission tomography.

OBJECTIVE: This study aimed to determine the key cost-effectiveness research questions relating to positron emission tomography (PET) in the UK. METHODS: A systematic literature review was conducted to establish the existing knowledge base relating to the cost-effectiveness of PET in the various conditions for which it has been proposed. A three-round postal Delphi study of relevant individuals was used to determine the key cost-effectiveness research questions relating to PET in the UK. The content and structure of the Delphi study was informed by the results of the literature review. RESULTS: The most important cost-effectiveness research priorities for the National Health Service (NHS) relating to PET were in the clinical areas of lung cancer, breast cancer and the assessment of myocardial viability. Gamma camera PET using coincidence imaging was highlighted as a modality whose, clinical role needed to be determined urgently. CONCLUSION: Underlying the cost-effectiveness research priorities which were established is the need for evidence that the use of the various PET modalities as a diagnostic technique will alter patient management as compared to existing diagnostic strategies. The findings of the project provide a contemporary overview of the potential role for PET in the NHS and will be relevant to other countries.

Cost-Benefit Analysis↗
PubMed1999

Positron emission tomography: establishing priorities for health technology assessment.

BACKGROUND: Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established. OBJECTIVES: This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK. METHODS: A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report. RESULTS: Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report. CONCLUSIONS: The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic

Female↗
PubMed1998

Which are the best information sources for identifying emerging health care technologies? An international Delphi survey.

The purpose of this survey was to assess potential information sources for identifying new health care technologies. A three-round Delphi study was conducted, involving 38 selected experts who suggested and assessed potential sources by applying agreed criteria. Twenty-six potential information sources were considered. Timeliness, time efficiency, and sensitivity were important criteria in determining which were the most important sources. The eight recommended sources were: pharmaceutical journals, pharmaceutical and biotechnology companies, specialist medical journals, key medical journals, medical engineering companies, private health care providers, newsletters and bulletins from other health technology assessment agencies, and groups of expert health professionals. There is a need to use a combination of sources because the most useful sources will vary according to the type of technology under consideration.

Communication↗
PubMed1998

Early warning of new health care technologies in the United Kingdom.

In this paper we describe the present range of organizations that have a role in the early warning of new and emerging health care technologies in the United Kingdom. We discuss in more detail the processes and prioritization criteria used by the U.K. horizon-scanning project for the NHS Health Technology Assessment Programme, and the principal methods of technology identification for the horizon-scanning project are outlined. The United Kingdom plans to develop an integrated system for the identification of technologies for commercial planning, health service research prioritization, financial planning, and provision of information to policy makers, purchasers, and providers of health care.

Diffusion of Innovation↗
PubMed1998

Giant aneurysms of the middle cerebral artery trifurcation treated with extracranial-intracranial arterial bypass and endovascular occlusion. Report of two cases.

Giant middle cerebral artery (MCA) trifurcation aneurysms that cannot be excluded directly can be treated by flow inversion achieved by creation of an extracranial-intracranial bypass distal to the aneurysm, followed by occlusion of the parent vessel proximal to the aneurysm. As opposed to surgical occlusion, endovascular occlusion avoids dissection of the aneurysm area, and the site of occlusion can be chosen according to the flow distribution demonstrated on angiography performed during test occlusions. Two patients with giant aneurysms of the MCA trifurcation benefited from flow inversion treatment. Forty-eight hours after an MCA-superficial temporal artery bypass had been created, the M1 segment was occluded by inserting a coil in the first patient and the internal carotid artery was occluded with balloons in the second patient (there was no communicating artery in the latter case). Both occlusions were performed immediately after a clinical test of occlusion tolerance. The patients were clinically intact during the postoperative course. Follow-up angiography performed 11 and 4 months, respectively, after vessel occlusion showed that the aneurysm occlusion was stable.

Adult↗
PubMed1998

Embolization of an orbital varix after surgical exposure.

We report a case of primary orbital varix treated by embolization with coils after surgical exposure and puncture of the venous ectasia. This method of treatment has the advantage of limiting traumatic dissection and avoiding difficult venous catheterization.

Adult↗
PubMed1997

Identifying new health care technologies in the United Kingdom.

We aimed to establish a 1996 baseline of new health care technologies that are predicted to have an impact on the United Kingdom's National Health Service in the next five years. One thousand and ninety-nine health care technologies were identified from a variety of sources. Further work will attempt to determine the most efficient method of identifying and monitoring new health care technologies.

Diffusion of Innovation↗
PubMed1997

Should general practitioners refer patients directly to physical therapists?

Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open access to a hospital-based physical therapist), and general practice fundholders are increasingly committing resources to ensure such services are available to their patients. This may lead to potential increases in costs as a larger total number of patients are treated owing to improved access and awareness of such services. A review of the available published literature found eight studies that compared two or more models of providing physical therapy services. Analysis of the studies revealed that there are several advantages for patients who are referred directly for physical therapy. The main advantages are significant reductions in waiting times, convenience, reduced costs for the patient and a lower cost per treated patient. There is also some evidence that the recovery time may be slightly better for patients who have direct access to a physical therapist.

Family Practice↗
PubMed1996

Intra-individual patterns of hormonal and affective adaptation to work demands: an n = 2 study of junior doctors.

This paper examines the detailed pattern of hormonal and affective response to natural variations in work demands, in relation to a taxonomy of adaptive response based on Frankenhaeuser's (1986) psychobiological analysis of coping modes and Hockey's (1993) regulatory control model. Two junior doctors were monitored every day over a 7-week period of work on a cardio-thoracic surgery ward. Measurements were made for each morning and afternoon work period of self-rated workload, effort and affective state, and the level of urinary catecholamines and cortisol. The de-trended data were analysed separately for the two individuals, using multivariate methods. Following reduction of work variables by principal components analysis, canonical correlation analyses were carried out for each individual. These revealed differences in the patterns of adaptation to two distinctive work contexts (enabling and demanding work) across the two doctors, as identified through loadings on two significant pairs of canonical variates. As expected, enabling work (high medical demands, with high personal resources) was associated with active coping in both subjects (low fatigue, high effort/adrenaline and low cortisol). However, demanding work (high general demands) was associated with marked differences between them in the pattern of loadings. One subject showed the strain pattern normally associated with effortful engagement in difficult tasks (high anxiety and fatigue, high effort/adrenaline), though without the anticipated reduction in cortisol. The response pattern of the other individual was indicative of passive coping (high anxiety and cortisol, with no effort/adrenaline component). The findings are interpreted in terms of the role of personal coping styles on the adaptive response to work demands. The use of canonical correlation methods with intra-individual data sets, although relatively unusual, appears to provide potentially valuable evidence on the nature of individual differences in the process of psychobiological response to stress underlying work-health relationships.

Adaptation, Psychological↗
PubMed1996

[The Order of Malta and its politics of health from the 14th to the 18th centuries].

The Order of Malta established in Jerusalem in the 12th century retreated to Saint Jean of Acra then to Cyprus in 1291, to Rhodes on 1310 and to Malta in 1530 to remain there until 1798. In Rhodes it erected an hospital called the "Collachium". The "Grand Maître" had for assistant in charge of the health the Hospitalier a man who was always the chief of the French Knights. In Malta, in 1593, was founded a great hospital or Sacred Infirmary, at la Valette with a staff of three doctors and two assistants, eight surgeons and assistants and a apothicary with three apothicaries and five assistants. The Malta University, including a Faculty of Medicine was founded in 1769 where they taught anatomy, chemistry, physiology, pathology, semeiologie, hygiene and therapeutics.

Education, Medical↗
PubMed1996

[Anterior and anterolateral surgery of the lower cervical spine (25 years after H. Verbiest). I: Technical bases].

The anterior approach to the cervical spine is currently a worldwide traditional surgical technique used by neurosurgeons or orthopedists in the treatment of traumatic, degenerative or tumoral cervical spinal lesions. Many original rules of these techniques were raised by pioneers as R. Cloward and H. Verbiest, and are still valid. Advances in the surgical armentarium and in bio-materials markedly improved the original technique and subsequently improved the clinical results. The present course was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was helded during the winter meeting in December 1995. The aim of this course is to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points are strengthened by the author's personal experience and comments. Part I presents the different anterior or antero-lateral approaches which any surgeon involved in cervical spine surgery actually needs to know. Secondly, the materials and technical basis needed to achieve an interbody graft or fusion or fixation are described. Lastly, some practical applications are detailed as a microdiscectomy, a medial or lateral cervical spine decompression, and the use of acrylic plastic or prothesis for a cervical vertebral replacement.

Bone Transplantation↗
PubMed1996

[Anterior and antero-lateral surgery of the lower cervical spine (25 years after H. Verbiest). 2: Indications, results, complications)].

The present course on the anterior and antero-lateral surgical approach of the lower cervical spine was organized for the neurosurgery trainees by the French Speaking Neurosurgical Society, and was held during the winter meeting in December 1995. The aim of this course was to recall the basic technical principles of the microsurgical anterior cervical approach, and to discuss the main indications of this surgical treatment. Many theoretical points were strengthened by the author's personal experience and comments. In Part I, the technical bases of the different anterior or antero-lateral approaches were presented (1996, 42 : 105-122). In the present Part II, the main indications of the anterior surgical approach to the cervical disk or the vertebral body are detailed, and the requirement of a bone graft and/or an osteosynthesis are discussed with their consequences on the final results. Secondly, variants of the surgical technics in use in case of cervical spinal instability are commented. Then various approaches to the cervical spinal tumors and to the vertebral artery are detailed and commented. Lastly, general and specific complications of the anterior cervical approach are listed with their rate of occurrence, and their prevention and management are discussed.

Cervical Vertebrae↗